Physiotherapy and Occupational Therapy for Juvenile Chronic Arthritis: Custom and Practice in Five Centres in the Uk, Usa and Canada

Abstract

Physiotherapy and occupational therapy are widely accepted as being of central importance for the treatment of juvenile chronic arthritis (JCA). However, these approaches have rarely been subject to critical scrutiny. The aims of this report are to highlight some of the inter-centre similarities and differences observed in the implementation of physical and occupational therapy for JCA, and to emphasize the need for scientifically controlled research in this area. During a series of visits to several paediatric rheumatology units in the UK, USA and Canada, three aspects of the service were noted: treatment philosophy, physical interventions used for the treatment of JCA and quality-of-life and independence training activities. There was general consensus with the philosophy that early physical intervention was a vital part of the treatment plan for JCA, although all therapists were concerned that compliance with treatment modalities was poor. Differences between units in the approach to acute arthritis, the use of foot orthoses and wrist splints, the treatment of joint contractures and the use of general quality-of-life training activities were noted. Although it was widely recognized that controlled research into the efficacy of physical intervention was needed, no centre had a co-ordinated plan for such investigations.

A survey of foot problems in juvenile idiopathic arthritis

“…The effi cacy of these interventions is unclear, although Brostrom et al (2004) reported a modest (6%) increase in walking speed following intra-articular corticosteroid injections, and Powell et al (2005) demonstrated the benefi ts of customized orthoses over prefabricated insoles or supportive athletic shoes for improving foot pain and function. Where necessary, input from other disciplines, including physiotherapy and occupational therapy (Hackett et al, 1996), may be of value to these children, but these were not accounted for in the present study.…”

Assessment and Management of Pain in Juvenile Idiopathic Arthritis

“…Interventions such as splinting and foot orthoses can correct deformities and malalignments and decrease pain (65). Several studies have shown that children with polyarticular JIA are less active than their healthy counterparts and exhibit reduced aerobic and anaerobic exercise capacity (66,67).…”

Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis

“…Water may be the only medium whereby some patients feel on an equal footing with their peers and exercise programmes can become a family activity. 8 Although hydrotherapy is commonly used in JIA, 28 little scientific evidence exists to support the use of this modality of treatment. Verhagen and colleagues published a systematic review assessing the effects of hydrotherapy (balneotherapy) for rheumatoid arthritis and osteoarthritis.…”